Interstitial Lung Disease Laboratory Battery

Ordering Physician: ________________________ Date: _____________

Physician Signature: ________________________Diagnosis: _________________

___ Antiphosphatidyl ethanolamine (IgG, IgM, IgA) - 823187 - RED

___ Antiphosphatidyl choline (IgG, IgM, IgA) - 823096 - RED

___ Antiphosphatidyl serine (IgG, IgM, IgA) - 117994 - RED

___ Myositis Profile - 273723 - RED

___ Jo-1 Antibody- RED

___ Anticardiolipin (IgG) - 161810 - RED

___ Anticardiolipin (IgM) - 161828 - RED

___ Anticardiolipin (IgA) - 161836 - RED

___ Antiphopholipid antibody - RED

___ Lupus anticoagulant - BLUE

___ Factor VIII - BLUE

___ Creatine kinase (CK)

___ Rheumatoid factor (RF)

___ Antinuclear antibody (ANA)

___ Extractable nuclear antibodies (ENA)

___ Scleroderma antibiody (SCL-70)

___ Basic Hypersensitivity pneumonitis panel

___ Exotic bird IgG hypersensitivity pneumonitis panel - Mayo #90508 - RED

___ Anti-neutrophil cytoplasmic antibody (ANCA)

___ Anti-proteinase 3

___ Anti-myeloperoxidase